SAEVA Proceedings 2018 4. Proceedings | Page 86

SAEVA Congress 2018 Proceedings | 12-15 February 2018 | ATKV Goudini Spa ulcers generally are very painful for horses and the iridocyclitis can be suppressed by the application of 1% atropine drops. Atropine not only causes cycloplegia but also stabilises the blood-aqueous barrier and the mydriasis maintains a visual axis and prevents posterior synechiae. Oral or systemic non steroidal anti inflammatory drugs should also be used. The melting component can be reduced by using serum which contains growth factors, fibronectin and vitamins which assist in supporting corneal epithelial cells. Ten percent acetylcysteine or 0.17% dipotassium EDTA can also be administered. The following treatment options have been described for stromal abscess [note the differentiation between ulcerated and non-ulcerated abscesses]. In spite of these medications, infected ulcers usually progress into deep corneal ulcers where Descemet’s membrane is reached and perforation of this 3-12µm membrane can occur. In these cases a surgical option is usually the best, not only to provide a blood supply with nutrients to the affected site but also give strength and stability to the defective area of the cornea. Placing a conjunctival pedical flap, corneal transposition grafts, intestinal mucosa grafts and amnion membrane transplantation are all viable treatment options. The goal of any ocular surface reconstruction [tectonic grafts] is to preserve the integrity of the globe, provide support, optimise the visual outcome and minimize the scar. 1] Topical medical management alone. This is a very conservative option and should initially be used but if there is no further improvement noted in a short time ideally a decision should be made for a more aggressive approach if possible. 2] Superficial keratectomy [SK]: This procedure is performed using a straight and beveled-up corneal knife or corneal elevator. An alternative to simply removing the epithelial layer, is an Algerbrush. SK alone may rid very superficial material and can aid penetration of drugs. 3] Superficial keratectomy with Conjunctival Pedical Graft [CPG]: A SK is performed over the site of the lesion and then the CPG is crafted from the bulbar conjunctiva and translocated onto the cornea so that this tissue can provide extra strength to the weakened cornea over the SK site. These grafts contain blood vessels and lymphatics, thus offering significant antibacterial, antifungal, antiviral, antiprotease, and anticollagenase effects. This is mediated via PMNs, antibodies, plasma, and α-2- macroglobulins which are brought directly into the corneal ulcer bed. 4] Superficial keratectomy and Amnion graft. Cryopreserved or freeze dried amnion, which is one of the layers from the fetal placenta has been shown as an excellent source of basement membrane or support structure for supporting the proliferation, migration and adhesion of new corneal epithelial cells This can be used to enhance healing by acting as a biologic bandage. Basically the amniotic membrane stroma gets repopulated with keratocyte derived cells and builds new tissue. This source of tissue will assist in suppressing inflammation and promoting corneal surface healing. The benefits of amnion grafting for contributing to corneal healing include: • • It is avascular [no blood vessels] Anti-inflammatory effects - IL-1ra, IL-10, Apoptosis 81